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Scientists have struggled for millennia to
understand human consciousness - the awareness of one's existence. Despite
advances in neuroscience, we still don't really know where it comes from, and
how it arises. But researchers think they might have finally figured out its
physical origins, after pinpointing a network of three specific regions in the
brain that appear to be crucial to consciousness.

It's a pretty huge deal for our understanding
of what it means to be human, and it could also help researchers find new
treatments for patients in vegetative states.

“For the first time, we have found a
connection between the brainstem region involved in arousal and regions
involved in awareness, two prerequisites for consciousness,” said lead
researcher Michael Fox from the Beth Israel Deaconess Medical Centre at Harvard
Medical School. “A lot of pieces of evidence all came together to point to this
network playing a role in human consciousness.”

Consciousness is generally thought of as being
comprised of two critical components - arousal and awareness. Researchers had
already shown that arousal is likely regulated by the brainstem - the portion
of the brain that links up with the spinal cord - seeing as it regulates when
we sleep and wake, and our heart rate and breathing.

Awareness has been more elusive. Researchers
have long thought that it resides somewhere in the cortex - the outer layer of
the brain - but no one has been able to pinpoint where. Now the Harvard team
has identified not only the specific brainstem region linked to arousal, but
also two cortex regions, that all appear to work together to form
consciousness. To figure this out, the team analysed 36 patients in hospital
with brainstem lesions - 12 of them were in a coma (unconscious) and 24 were
defined as being conscious.

The researchers then mapped their brainstems
to figure out if there was one particular region that could explain why some
patients had maintained consciousness despite their injuries, while others had
become comatose. What they found was one small area of the brainstem - known as
the rostral dorsolateral pontine tegmentum - that was significantly associated
with coma. Ten out of the 12 unconscious patients had damage in this area,
while just one out of the 24 conscious patients did.

That suggests that this tiny region of the
brainstem is important for consciousness, but it's not the full story. To
figure out which other parts of the brain were fully connected to this region,
the team looked at a brain map - or connectome - of a healthy human brain,
which shows all the different connections that we know of so far in our brains
(you can see a connectome in the image at the top of this story).

They identified two areas in the cortex that
were linked up to the rostral dorsolateral pontine tegmentum, and were most
likely to play a role in regulating consciousness. One was in the left,
ventral, anterior insula (AI), and the other was in the pregenual anterior
cingulate cortex (pACC). Both of these regions have been linked by previous
studies to arousal and awareness, but this is the first time they've been
connected to the brainstem.

The team double-checked their work by looking
at fMRI scans of 45 patients in comas or vegetative states, and showed that all
of them had the network between these three regions disrupted. It's a pretty
exciting first step, but the researchers acknowledge that they now need to
verify their find across a larger group of patients.

Independent teams will also need to confirm
their results before we can say for sure that these three regions are the
physical source of consciousness in our brains. In the meantime, the research
will hopefully lead to new treatment options for patients in comas and
vegetative states, who might have otherwise healthy brains but simply can't
regain consciousness.

“This is most relevant if we can use these
networks as a target for brain stimulation for people with disorders of
consciousness,” said Fox. “If we zero in on the regions and network involved,
can we someday wake someone up who is in a persistent vegetative state? That’s
the ultimate question.”

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